Hospitals Try Yogurt to Prevent Infections in Patients

For people on antibiotics, probiotics can stymie a common, virulent bug

Laura Landro

At Holy Redeemer Hospital in Meadowbrook, Pa., a worrisome trend emerged in 2011: an uptick in cases of one of the most virulent hospital infections, despite measures to battle the bug by scrubbing surfaces with bleach and isolating affected patients.

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But the hospital was able to drive down cases last year after adding a new weapon to its arsenal: probiotics, the small organisms that help maintain the natural balance of bacteria in the intestines.

Contained in supplements and foods such as yogurt, probiotics are of growing interest in health care for their potential in helping to treat a number of conditions, including irritable bowel syndrome, tooth decay and chronic fatigue syndrome.

Now, Holy Redeemer and other hospitals are experimenting with probiotics as a preventive measure for patients who are on antibiotics. For all their infection-fighting power, antibiotics kill the good bugs along with the bad in the intestine. The result is an imbalance in the gut that can lead a bacterium known as Clostridium difficile—C. diff for short—to colonize and produce a toxin that can cause diarrhea, dehydration and fever. In severe cases, C. diff infections can lead to kidney failure, recurrent infection and death.

A common strain of probiotic, Lactobacillus reuteri protectis

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C. diff spores are hardy, surviving on surfaces such as doorknobs and countertops. Soap and water can remove them from hands, but alcohol-based hand cleaners commonly used in hospitals don't effectively destroy them. According to the Centers for Disease Control and Prevention, C. diff is rapidly increasing and is linked to 14,000 deaths annually. A study earlier this year in JAMA Internal Medicine estimated the infections cost as much as $1.8 billion annually. Hospital patients with a positive clinical culture for C. diff are 40% likelier to be readmitted within a year than other patients, according to a 2012 study.

Most Effective Strains

Probiotics also are being studied in patients who suffer from a less severe but often debilitating complication, antibiotic-associated diarrhea. Analyses by researchers at Maimonides Medical Center in Brooklyn, N.Y., in 2011 found that using probiotics for periods ranging from a few days to three weeks reduced a patient's odds of developing antibiotic-associated diarrhea by 60%. And a RAND Corp. study last year of many published studies also found probiotics useful in preventing or treating antibiotic-associated diarrhea.

There are several different strains and multiple formulations of probiotics, and research is lacking on the most effective type and dosage, though data has shown that the strains Lactobacillus and Bifidobacterium seem to be most effective.

Erik R. Dubberke, associate professor at Washington University School of Medicine in St. Louis, says there isn't enough data to endorse probiotics for routine C. diff prevention in hospitalized patients. Probiotics may also actually cause infection in some patients, "so they are not entirely without risk," Dr. Dubberke notes.

However, he says, probiotics are worth investigating further. He is conducting a study of intensive-care patients, randomizing them to a probiotic Lactobacillus rhamnosus (sold under the brand name Culturelle) or no probiotic. Based on the preliminary findings, he plans a second, larger study to look at how many patients on antibiotics become colonized with C. diff and how many develop an infection.

Big ROI

Holy Redeemer won an innovation award this year from the Hospital and Healthsystem Association of Pennsylvania for the probiotics program, which grew from a suggestion by a surgeon on the hospital's infection-prevention committee. Anne Kathryn Bromm, clinical nutrition coordinator, and Jeanie Ryan, clinical nutrition manager, used a Dannon yogurt brand stocked by the hospital. (Not all yogurts have the same cultures, and makers sometimes add extra ones to claim more benefits.)

Starting in January 2012, dietitians got a daily list of patients who had orders for antibiotics for more than one day, and met with each to discuss the potential benefits of probiotics, suggesting two six-ounce portions of yogurt daily. "Patients were pretty agreeable," Ms. Bromm says.

The number of C. diff cases fell to 23 infections in 2012, a 4% infection rate, from 75 in 2011, a 12.5% rate. This year, through September, there were 18 infections. On average, studies show, the infections cost $35,000 to treat, and Ms. Ryan says the savings "more than compensate for the cost of the yogurt."